Document Detail


Idiopathic aldosteronism masquerading as discrete aldosterone-secreting adrenal cortical neoplasms among patients with primary aldosteronism.
MedLine Citation:
PMID:  2588119     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The medical records of 32 patients with primary aldosteronism who underwent adrenalectomy at the University of Michigan Medical Center from January 1975 to February 1988 were reviewed. All 32 patients had the preoperative diagnosis of aldosterone-secreting adrenal cortical neoplasms. Based on pathology reports, however, 21 of 32 (66%) patients were confirmed to have adrenal cortical neoplasms. Ten of 32 (31%) patients had nodular hyperplasia, and 1 of 32 (3%) had diffuse hyperplasia. This report focuses on the results in 11 patients with idiopathic aldosteronism. In six of nine (67%) patients, aldosterone levels rose within 4 hours of patients assuming an upright posture after salt loading. Seven patients had selective adrenal venous aldosterone/cortisol ratios that were interpreted to lateralize to one adrenal gland; however, only four of seven (57%) had ratios of 3:1 or greater than the contralateral adrenal gland. In 6 of 11 (55%) patients, adrenal scans (NP-59) initially demonstrated unilateral uptake. Three of four computerized axial tomographic scans demonstrated a unilateral adrenal mass. Only 3 of 11 (27%) patients with idiopathic aldosteronism were normotensive after surgery. Four of 11 (36%) patients' conditions were improved, in that they became normotensive with antihypertensive medication. These data suggest that if both imaging and functional studies lateralize to one adrenal gland, it is reasonable to expect either a cure or an improvement after adrenalectomy among patients with primary aldosteronism caused by idiopathic aldosteronism. Unilateral adrenalectomy may be the treatment of choice in carefully selected patients with nodular hyperplasia causing primary aldosteronism.
Authors:
M K McLeod; N W Thompson; M D Gross; R J Grekin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  106     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1989 Dec 
Date Detail:
Created Date:  1990-01-08     Completed Date:  1990-01-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1161-7; discussion 1168     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48104-0331.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex / pathology
Adrenal Cortex Neoplasms / diagnosis*,  pathology,  secretion,  surgery
Adrenalectomy
Adult
Aldosterone / blood,  secretion*
Blood Pressure
Diagnosis, Differential
Female
Humans
Hydrocortisone / blood
Hyperaldosteronism / diagnosis*,  etiology
Hyperplasia
Male
Posture
Sodium Chloride / diagnostic use
Chemical
Reg. No./Substance:
50-23-7/Hydrocortisone; 52-39-1/Aldosterone; 7647-14-5/Sodium Chloride

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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